Cost and clinical effectiveness of fixed-dose combination therapies in the treatment of glaucoma patients: a systematic review
https://doi.org/10.17749/2070-4909/farmakoekonomika.2025.326
Abstract
Background. Primary open-angle glaucoma (POAG) is a chronic, progressive eye condition causing optic nerve damage and irreversible vision loss by increasing intraocular pressure (IOP). Therapy primarily aimed at reducing IOP to prevent disease progression. Pharmacoeconomic evaluation of fixed-dose combinations (FDCs) has attracted growing interest in recent years as a strategy to enhance both treatment efficacy and accessibility.
Objective: To review the cost and clinical effectiveness for FDCs of travoprost/timolol (TT) and latanoprost/timolol (LT) for POAG treatment.
Material and methods. A systematic literature review was conducted using PubMed/MEDLINE, Web of Science, ScienceDirect, and Google Scholar databases. The sampling included studies evaluating FDCs of TT and LT in terms of its cost and clinical effectiveness, as well as cost-effectiveness and cost-utility ratios.
Results. TT-FCD proved to be more cost-effective than LT-FDC in several European countries and the Philippines, resulting in lower long-term costs and slowing the progression of vision loss. Conversely, in China identified LT-FDC was more cost-effective due to lower daily costs. Both FDC options improved patient adherence to treatment due to their simplified administration.
Conclusion. TT-FCD may be a more favorable treatment option for POAG in certain regions, considering its pharmacoeconomic and clinical advantages. However, treatment selection should be individualized based on regional healthcare dynamics, medicine pricing, and patient access to medicines.
About the Authors
Sh. Z. Umarova
Institute of Pharmaceutical Education and Research
Uzbekistan
Uzbekistan
Shakhnoz Z. Umarova, Dr. Sci. Med., Prof.
46-48 Dekhkanabad Str., Quarter 19, Yunusabad District, Tashkent 100114, Republic of Uzbekistan
Z. R. Usmonova
Institute of Pharmaceutical Education and Research
Uzbekistan
Uzbekistan
Zoya R. Usmonova
46-48 Dekhkanabad Str., Quarter 19, Yunusabad District, Tashkent 100114, Republic of Uzbekistan
N. M. Normatova
Republican Center for Advanced Training and Specialization of Secondary Medical and Pharmaceutical Workers under the Ministry of Health of the Republic of Uzbekistan
Uzbekistan
Uzbekistan
Nargiza M. Normatova, Dr. Sci. Med., Assoc. Prof.
2/3 2nd Shifokorlar Str., Almazar District, Tashkent 100109, Republic of Uzbekistan
N. M. Sultanbayeva
Institute of Pharmaceutical Education and Research
Uzbekistan
Uzbekistan
Nargiza М. Sultanbayeva, PhD
46-48 Dekhkanabad Str., Quarter 19, Yunusabad District, Tashkent 100114, Republic of Uzbekistan
References
1. Neelakantan A., Vaishnav H.D, Iyer S.A, Sherwood M.B. Is addition of a third or fourth antiglaucoma medication effective? J Glaucoma. 2004; 13 (2): 130–6. https://doi.org/10.1097/00061198-200404000-00008.
2. Erichev V.P. Modern principles of hypotensive therapy of glaucoma. In: Scientific and practical conference “Glaucoma: reality and prospects”: collection of scientific articles. Moscow, September 25–26, 2008. Мoscow; 2008: 220–3 (in Russ.).
3. European Glaucoma Society. Terminology and Guidelines for Glaucoma. 4th ed. Savona, Italy: PubliComm; 2014. https://doi.org/10.1136/bjophthalmol-2016-egsguideline.001.
4. Kass M.A., Heuer D.K., Higginbotham E.J., et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002; 120 (6): 701–13. https://doi.org/10.1001/archopht.120.6.701.
5. Erichev V.P., Dugina A.E., Mazurova Yu.V. Fixed combinations in glaucoma treatment: particular case. Glaucoma. 2010; 1: 62–5 (in Russ.).
6. Kuroyedov A.V. Prospects of combined antiglaucoma drugs usage (literary review). Russian Medical Journal. 2007; 4: 176–81 (in Russ.).
7. Robin A.L., Covert D. Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? Ophthalmology. 2005; 112 (5): 863–8. https://doi.org/10.1016/j.ophtha.2004.12.026.
8. Van Wijk B.L., Klungel O.H., Heerdink E.R., de Boer A. Rate and determinants of 10-year persistence with antihypertensive drugs. J Hypertens. 2005; 23 (11): 2101–7. https://doi.org/10.1097/01.hjh.0000187261.40190.2e.
9. Guven S., Koylu M.T., Mumcuoglu T. Adherence to glaucoma medication, illness perceptions, and beliefs about glaucoma: attitudinal perspectives among Turkish population. Eur J Ophthalmol. 2021; 31 (2): 469–76. https://doi.org/10.1177/1120672120901687.
10. Robin A., Grover D.S. Compliance and adherence in glaucoma management. Indian J Ophthalmol. 2011; 59 (Suppl. 1): S93–6. https://doi.org/10.4103/0301-4738.73693.
11. Tsai J.C., McClure C.A., Ramos S.E., et al. Compliance barriers in glaucoma: a systematic classification. J Glaucoma. 2003; 12 (5): 393–8. https://doi.org/10.1097/00061198-200310000-00001.
12. Newman-Casey P.A., Robin A.L., Blachley T., et al. The most common barriers to glaucoma medication adherence: a cross-sectional survey. Ophthalmology. 2015; 122 (7): 1308–16. https://doi.org/10.1016/j.ophtha.2015.03.026.
13. Barnebey H.S., Robin A.L. Adherence to fixed-combination versus unfixed travoprost 0.004%/timolol 0.5% for glaucoma or ocular hypertension: a randomized trial. Am J Ophthalmol. 2017; 176: 61–9. https://doi.org/10.1016/j.ajo.2016.12.002.
14. Windham B.G., Griswold M.E., Fried L.P., et al. Impaired vision and the ability to take medications. J Am Geriatr Soc. 2005; 53 (7): 1179–90. https://doi.org/10.1111/j.1532-5415.2005.53376.x.
15. Stewart W.C., Konstas A.G.P., Pfeiffer N. Patient and ophthalmologist attitudes concerning compliance and dosing in glaucoma treatment. J Ocul Pharmacol Ther. 2004; 20 (6): 461–9. https://doi.org/10.1089/jop.2004.20.461.
16. Higginbotham E.J., Hansen J., Davis E.J. et al. Glaucoma medication persistence with a fixed combination versus multiple bottles. Curr Med Res Opin. 2009; 25 (10): 2543–7. https://doi.org/10.1185/03007990903260129.
17. Nixon D. Randomized, parallel comparison of the efficacy and tolerability of twice-daily Combigan® vs. Cosopt® fixed-combination therapies in patients with glaucoma or ocular hypertension. In: World Glaucoma Congress. Singapore, July 18–21, 2007. Abstracts book. Geneva; 2007: 171.
18. Rossi G.C., Pasinetti G.M., Scudeller L., et al. Monitoring adherence rates in glaucoma patients using the Travatan Dosing Aid. A 6-month study comparing patients on travoprost 0.004% and patients on travoprost 0.004%/timolol 0.5% fixed combination. Expert Opin Pharmacother. 2010; 11 (4): 499–504. https://doi.org/10.1517/14656561003601994.
19. Noecker R.J., Awadallah N.S., Kahook M.Y. Travoprost 0.004%/timolol 0.5% fixed combination. Drugs Today. 2007; 43 (2): 77–83. https://doi.org/10.1358/dot.2007.43.2.1032058.
20. Herceg M., Noecker R. Travoprost/timolol fixed combination. Expert Opin Pharmacother. 2008; 9 (6): 1059–65. https://doi.org/10.1517/14656566.9.6.1059.
21. Zhao J.L., Ge J., Li X.X., et al. Comparative efficacy and safety of the fixed versus unfixed combination of latanoprost and timolol in Chinese patients with open-angle glaucoma or ocular hypertension. BMC Ophthalmol. 2011; 11: 23. https://doi.org/10.1186/1471-2415-11-23.
22. Schmier J.K., Halpern M.T., Covert D.W, Robin A.L. Travoprost versus latanoprost combinations in glaucoma: economic evaluation based on visual field deficit progression. Curr Med Res Opin. 2006; 22 (9): 1737–43. https://doi.org/10.1185/030079906X121011.
23. Hommer A., Wickstrøm J., Friis M.M., et al. A cost-effectiveness analysis of fixed-combination therapies in patients with open-angle glaucoma: a European perspective. Curr Med Res Opin. 2008; 24 (4): 1057–63. https://doi.org/10.1185/030079908X280626.
24. Bergström A., Maurel F., Le Pen C., et al. Daily costs of prostaglandin analogues as monotherapy or in fixed combinations with timolol, in Denmark, Finland, Germany and Sweden. Clin Ophthalmol. 2009: 3: 471–81. https://doi.org/10.2147/opth.s6811.
25. Azarcon C.P., Florcruz N.V.D.G. The daily, monthly, and annual cost of glaucoma therapy using ocular hypotensive eye drops in the Philippines based on a quantitative method. Philippine J Ophthalmol. 2020; 45 (2): 84–96.
26. Xu C., Guo R., Huang D., et al. Daily costs and cost effectiveness of glaucoma fixed combinations in China. J Ophthalmol. 2020; 2020: 2406783. https://doi.org/10.1155/2020/2406783.
27. Patel A.R., Schwartz G.F., Campbell J.H., et al. Economic and clinical burden associated with intensification of glaucoma topical therapy: a us claims-based analysis. J Glaucoma. 2021; 30 (3): 242–50. https://doi.org/10.1097/IJG.0000000000001730.
28. Fujita A., Hashimoto Y., Okada A., et al. Practice patterns and costs of glaucoma treatment in Japan. Jpn J Ophthalmol. 2023; 67 (5): 590–601. https://doi.org/10.1007/s10384-023-01002-w.
29. Petrov S.Yu., Yakubova L.V., Markelova O.I. Modern trends in the treatment of glaucoma. Russian Ophthalmological Journal. 2024; 17 (1): 136–43 (in Russ.). https://doi.org/10.21516/2072-0076-2024-17-1-136-143.
30. Tuulonen A. Cost-effectiveness of screening for open angle glaucoma in developed countries. Indian J Ophthalmol. 2011; 59 (Suppl. 1): S24–30. https://doi.org/10.4103/0301-4738.73684.
31. Ofei-Palm C.N.K., Tagoe N.N., Jatoe D., et al. Сost analysis and rational use of anti-glaucoma therapy in a tertiary hospital in Ghana. Clinicoecon Outcomes Res. 2021; 13: 619–27. https://doi.org/10.2147/CEOR.S311058.
32. Kernohan A., Homer T., Shabaninejad H., et al. Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma. Br J Ophthalmol. 2023; 107 (10): 1452–7. https://doi.org/10.1136/bjophthalmol-2021-320887.
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For citations:
Umarova Sh.Z., Usmonova Z.R., Normatova N.M., Sultanbayeva N.M. Cost and clinical effectiveness of fixed-dose combination therapies in the treatment of glaucoma patients: a systematic review. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. (In Russ.) https://doi.org/10.17749/2070-4909/farmakoekonomika.2025.326
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